Employment Application

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT
but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years.

Personal Information

First Name*

Middle Name

Last Name*

Home Phone*

Work Phone

Cell Phone

Email Address*

Addresses

Street*

City*

State*

Zip Code*

Since (Mo/Yr)*

To (Mo/Yr)

Current Address *

Prior Address

Prior Address:

Education

School Attended

City

State

Diploma

Degree/Cert.

Area of Study

High School

No
Yes

GED

Undergrad School

No
Yes

Grad School

No
Yes

Other School

No
Yes

Employment Information

Position Applied For

Date You Can Start

(yyyy-mm-dd)

Desired Salary: $

Do You Prefer

Can you work

Weekends
Evenings

Are you available for shift work?

No
Yes

Not Available

Please answer all of the following questions.

1.

Are you at least 18 years of age and legally eligible to work for our company in the United States?

No
Yes

If you are under 18 years of age, can you provide required proof of your eligibility to work?

No
Yes

2.

Have you ever been discharged or asked to resign from a job?

No
Yes

If yes, please explain...

3.

Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?

No
Yes

If yes, please explain...

4.

Do any of your friends or relatives, other than spouse, work here?

No
Yes

If yes, state name and relationship...

Employment History

Are you currently employed?

No
Yes

May we contact your present employer?

No
Yes

Most Recent Employer

Prior Employer

Prior Employer

Prior Employer

Employer

City

State

Zip Code

Phone

Position Held

From (m/yyyy)

To (m/yyyy)

Pay upon leaving

Supervisor

Duties

Reason For Leaving

Job-related Skills

1.

Do you have a valid driver's license?

No
Yes

If yes, Driver's License Number

Date of Issue

Resume (Text Version)

Copy and Paste a text version of your resume here or fill out the employment history fields below.

The company and other persons or employers are released from all liability brought forth by any investigation resulting from my submission of this electronic application and the data contained here in.

2.

The information in this application is true and complete to the best of my knowledge. Any falsification, misrepresentation, or omission on this application can be cause for denial or termination of employment.

3.

If hired, my employment is voluntary, meaning that either party can employment at any time for any reason. Upon acceptance of employment if a position is offered, I agree to abide by all existing and future company rules and regulations. The company reserves the right to change any working agreement as deemed necessary.

4.

Any employment offer is contingent open my providing proof of identity and eligibility to work the country of employ.

5.

I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.

6.

I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding contract.